Open Enrollment Participation Program for 2019

Open enrollment is upon us! Medicare contractors conduct an open participation enrollment period, every year, to give eligible physicians, practitioners and suppliers an opportunity to enroll in Medicare as participating providers or terminate enrollment in the participation program.

Providers will receive a postcard in the mail stating that it is open enrollment time. This is generally from Mid-November to the end of December.  For more information, please review the Open Enrollment page on the Noridian Medicare website for details about this year's open enrollment.

If a change is not needed to the current participation status, no action is needed. Providers' current status will roll over automatically to the next calendar year. If a change is needed to be made, the request must be postmarked within the open enrollment dates. Billing will need to be held until notified of status change. Noridian is unable to submit claims revisions on your behalf for this reason. This open enrollment cycle runs from November 14, 2018 through December 31, 2018.

When Medicare providers complete and sign the participation agreement (CMS-460 Form), the provider agrees to accept assignment for all covered services that are provided to Medicare patients. The CMS Internet Only Manual (IOM), Publication 100-04, Chapter 1, Section 30.3.12 outlines the annual open enrollment process. The benefits of signing a participation agreement include:

  • Higher Fee Schedules: The fee schedule amount is five percent higher than that for a   non-participating provider.
  • Payment Information Forwarded to Supplemental Insurers (Medigap): Claim payment information will be forwarded to the patient's supplemental insurer if the name, address, and policy number of the Medigap insurer is shown on the claim form prefaced by the word "MEDIGAP", "MG" or "MGAP." (See the CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 28, Section 70.6, for more information regarding the eligibility-file based crossover process.)
  • Direct Payment: Participants receive direct and timely reimbursement from Medicare.

View More Information on Open Enrollment and Eligibility

 

Last Updated Nov 08, 2018